Eye & Contact Lens-Science and Clinical Practice最新文献

Objectives: To evaluate the impact of a new orthokeratology (OrthoK) lens on corneal epithelial thickness and higher-order aberrations (HOAs).

Methods: This three-arm, prospective, crossover study randomly assigned participants to the control group, T1 group (1.5× control-group lens-design reverse curve [RC] height), and T2 group (2× control-group lens-design RC height). Participants underwent basic ophthalmological examinations, corneal topography, and corneal epithelial thickness and HOA measurements at each visit. Corneal zones were analyzed based on topographic changes induced by lens wear, corresponding to the central treatment zone and the reverse zone.

Results: The spherical equivalent was significantly lower in T1 and T2 than in the control group on days 7 and 28 of lens wear ( P <0.001). The corneal curvature was noticeably flatter in T1 and T2 than in the control group. No significant differences were observed among groups in the epithelial thickness of the central treatment zone after OrthoK lens wear. However, epithelial thickness in the reverse zone was significantly greater ( P <0.05) in T1 and T2 compared with the control group after 28 days of lens wear. A significant difference in HOA was observed among the three groups after OrthoK lens wear for 1 and 7 days ( P <0.01). T2 demonstrated higher levels of HOA than the other groups.

Conclusions: This new design of OrthoK can alter the corneal epithelium thickness and stabilize central corneal flattening, thereby achieving a better correction for myopia. However, this design also induces HOAs and is associated with a mild but significant compromise in uncorrected visual acuity compared with conventional designs. Therefore, clinicians should weigh the potential benefits of myopia control against the associated effects on visual quality when selecting OrthoK lens designs.

Objective: Microbial keratitis (MK) is a vision-threatening and often painful corneal infection. This study aims to quantify severity of symptoms of MK at presentation and investigate their association with visual acuity (VA).

Methods: The Automated Quantitative Ulcer Analysis (AQUA) study recruited MK patients from two sites (University of Michigan and Aravind Eye Care System). At presentation, best-corrected VA was recorded. Patients were surveyed on severity of symptoms on a five-point scale for pain or a four-point scale for redness, light sensitivity/glare, and blurry vision. The association between symptom severity and VA was tested with Spearman correlations (r) and Kruskal-Wallis tests.

Results: Seven hundred three patients with MK were enrolled in the AQUA study from July 2020 to November 2022. Presenting logMAR VA had a median value of 1.3 (Snellen equivalent, 20/400). Most patients reported pain (98.7%), redness (99.1%), light sensitivity/glare (98.4%), and blurry vision (99.2%). Visual acuity showed a significant correlation with cumulative symptom severity (spearman r=0.15, P <0.0001). For those who reported pain and blurry vision, VA worsened with increasing symptom severity ( P <0.0001).

Conclusions: Presenting VA showed a significant positive correlation with cumulative symptom severity and the individual symptoms of pain and blurry vision. Patient-reported symptoms at MK presentation may indicate disease severity.

Purpose: To estimate the efficacy of orthokeratology contact lenses in slowing myopia progression.

Methods: Prospective data from 101 to 88 children, aged 6 to 12 years and with myopia between -0.50 and -5.00 D, who completed 2 years of orthokeratology and single-vision spectacle lens wear, respectively, were analyzed post hoc. The relationship between changes in mean spherical refractive error (MSE) and axial length (AL) in the control group (spectacle wearers) was assessed and subsequently used to convert changes in AL into changes in MSE for the orthokeratology group.

Results: Relatively strong correlations were found between changes in MSE and AL relative to baseline for the control group at all time points, including 0.5-, 1-, 1.5-, and 2-year intervals after lens wear (all P <0.001). The estimated mean changes in MSE (± SD) at 24 months in comparison with baseline for orthokeratology and control groups were -0.77±0.51 and -1.24±0.71 D, respectively. Thus, it is estimated that orthokeratology lenses slow the increase in MSE versus the control by -0.47 D.

Conclusions: This study estimates that orthokeratology lenses reduce myopia progression by -0.47 D after 2 years of lens wear in comparison with spectacle wear. These results might be useful for eye care practitioners engaged in fitting orthokeratology lenses for myopia management.

Objective: Orthokeratology (Ortho-K) effectively controls myopia progression. Toric Ortho-K lenses are used for moderate-to-high astigmatism, but predictive models with multiple corneal parameters are limited. This study aimed to identify key predictors for toric lens prescription in Ortho-K.

Methods: A retrospective analysis was conducted on 506 patients undergoing Ortho-K treatment, incorporating 15 parameters such as age, sex, refractive error, corneal astigmatism, and flat eccentricity. Using both univariate and multivariate models, significant predictors were identified using logistic regression and refined with backward stepwise regression, evaluated by receiver operating characteristic curve analysis.

Results: The 4-variable model (corneal astigmatism [∆K], steep eccentricity [Steep e], Sagittal Height Difference at 8 mm [SD8], and Corneal Cylindrical to Spherical [C/S] ratio) achieved an area under the curve (AUC) of 0.92 (sensitivity 89.7%, specificity 79.5%). Receiver operating characteristic analysis validated thresholds: ∆K>1.50 D (AUC 0.87), SD8 greater than 34 μm (AUC 0.82), flat eccentricity greater than 0.68 (AUC 0.73), and C/S ratio greater than 0.59 (AUC 0.63).

Conclusion: This study developed the 4-variable model for toric Ortho-K lens fitting, identifying corneal astigmatism and SD8 as key predictors for detecting limbus-to-limbus astigmatism. Steep and flat eccentricities offered predictive and clinical insights, respectively.

Objectives: To analyze the literature comparing the efficacy of orthokeratology lenses (OKLs) with small (≤5.5 mm) and large (≥6.0 mm) optical zone diameter (OZD) on myopia control.

Methods: A systematic review was conducted using PubMed and Scopus databases identifying seven articles that met the eligibility criterion. The quality assessment was checked using the Critical Appraisal Skills Programme standard checklist. A meta-analysis focused on the axial length (AL) growth was conducted.

Results: Six clinical trials and one pseudo experimental pre-post study were evaluated. All articles found a significantly slower AL increase in wearers with small OZD, which was confirmed through the meta-analysis (mean difference = -0.13, 95% confidence interval [-0.18/-0.10], P < 0.001). In four articles, the use of smaller OZD resulted in an increase in higher-order aberrations. The quality analysis revealed a low level of bias in six out of the seven articles. Common strengths included a clearly defined research question, random OKLs assignment, comparable baseline groups, and consistent care levels. Common weaknesses were the absence of cost-effectiveness analysis and lack of blinding for data analysts.

Conclusions: There is consistent evidence supporting that OKLs with OZD of 5.0 mm provide a better control of myopia progression compared with those with an OZD of ≥6.0 mm.

Abstract: Superior limbic keratoconjunctivitis (SLK) is a chronic inflammatory ocular surface disorder affecting the superior conjunctiva and limbus. Its pathogenesis entails a vicious cycle of microtrauma and inflammation. Besides its well-known association with thyroid disorders, SLK has also been associated with systemic conditions involving severe ocular surface disease. One condition that can secondarily develop SLK is ocular graft-versus-host disease (oGVHD). Ocular graft-versus-host disease, a complication of allogeneic hematopoietic stem-cell transplantation, is a pan-ocular surface disease that can lead to severe ocular complications and vision loss. Importantly, the occurrence of SLK in the setting of oGVHD is a marker of an augmented ocular surface distress that requires immediate aggressive management to prevent irreversible ocular surface damage, notably limbal stem-cell deficiency. Treatment of SLK in oGVHD includes aggressive lubrication, anti-inflammatory drops, serum/plasma drops, and large diameter contact lenses. In particular, scleral contact lenses are currently the most effective long-term treatment for SLK in oGVHD and can significantly reduce the risk of irreversible loss of vision. Of note, conjunctival resection or destruction (e.g., cauterization) is not recommended for treatment of SLK in ocular graft-versus-host disease. This review examines the pathophysiology and treatment modalities for SLK in oGVHD aimed at improving long-term outcomes.

Purpose: To evaluate tear secretory response using a novel device, the i-Onion, which stimulates lacrimal gland activity with concentrated CO 2 bursts.

Methods: The i-Onion device delivers a controlled CO 2 burst to the ocular surface, stimulating the lacrimal gland's tear production response. We studied 120 participants: 40 with glaucoma, 40 with cataracts (some followed postsurgery), and 40 controls. Basal tear volume (BTV) was measured using a 3-min unanesthetized the Schirmer test. Stimulated tear volume was then recorded over another 3 min after a 3-second i-Onion stimulus. Tear reserve volume (TRV), the study's primary outcome, was calculated as the difference between stimulated tear volume and BTV.

Results: Participants' mean age was 60.5 years; 78% male, 59% White. No significant differences in TRV were found among the groups (glaucoma: 9.3 mm; cataract: 8.3 mm; control: 7.9 mm, P =0.67) but BTV was significantly lower in patients with glaucoma and cataract compared with controls (glaucoma: 13.6 mm; cataract: 14.1 mm; control: 19.0 mm, P =0.03). Basal tear volume also decreased with age (r=-0.2, P =0.01). Presurgical TRV in patients with cataract showed a nonsignificant negative correlation with postsurgical ocular symptoms (r=-0.23, P =0.2).

Conclusion: The i-Onion device demonstrated that TRV was preserved in elderly individuals with glaucoma and cataract, despite decreased BTV with age and disease.

Objectives: To investigate the effect of overnight orthokeratology (OOK) on ocular surface and blinking patterns in children and adolescents.

Methods: A prospective cohort study was conducted including 27 eyes of 27 children from Beijing Tongren Hospital who received OOK correction and 31 eyes of 31 spectacle wearing children. Tests were performed before and at 3 and 6 months after OOK wear. Ocular surface assessment included tear meniscus height, noninvasive tear breakup time, lipid layer thickness, number of incomplete blinks, number of total blinks, and fluorescein tear breakup time.

Results: Before treatment, there were no statistically significant differences in various indicators between the two groups. After wearing OOK for 3 months and 6 months, there were no significant differences between the tear meniscus height, noninvasive tear breakup time, lipid layer thickness, number of incomplete and total blinks, fluorescein tear breakup time groups, and upper and lower lid meibomian gland atrophy rate ( P >0.05). However, the corneal fluorescein staining scores in the OOK group were significantly higher than those in the spectacle group ( P <0.001).

Conclusions: Short-term use of OOK in children and adolescents has a relatively minor impact on ocular surfaces and is considered relatively safe to use. However, it significantly increases corneal fluorescein staining scores, which may suggest the presence of corneal epithelial damage.

Abstract: Vernal keratoconjunctivitis (VKC) is a seasonally recurring form of allergic conjunctivitis that leads to bilateral inflammation of the cornea and conjunctiva. Symptoms may include itching, foreign body sensation, discharge, and conjunctival hyperemia. Severe cases may result in corneal complications including erosions, shield ulcers, plaques, microbial keratitis, corneal scarring, limbal stem cell deficiency, and keratoconus. Epidemiological data reveal that it mainly affects children and young adults, with male predominance and a higher prevalence in warmer climates. The etiology is multifactorial, involving triggers from environmental allergens. Both type I and type IV hypersensitivity reactions have been implicated. Vernal keratoconjunctivitis may significantly impact visual acuity and quality of life, especially in school-aged children. Management strategies include allergen avoidance, topical treatments, and immunomodulators. Despite therapeutic advances, VKC remains a significant cause of morbidity, highlighting the need for prompt diagnosis and treatment to mitigate long-term impacts on vision and quality of life.

Purpose: To evaluate the outcomes of patients with corneal neovascularization treated with intrastromal injection of bevacizumab and corneal fine needle diathermy (FND).

Methods: This is a retrospective case series of six patients with at least 6 months follow-up after intrastromal injection of bevacizumab and FND. The main outcome measures include change in best-corrected visual acuity (BCVA) and regression of corneal neovascularization at follow-up. Slitlamp photographs were taken pre and post procedure.

Results: The mean age of the patients was 64.2 years, and the baseline BCVA ranged from 20/40 to 20/100. At postoperative months 1 and 6, all patients had improvement in corneal neovascularization, with 67% (4/6) showing total resolution while 33% (2/3) had residual deep fine vessels. Best-corrected visual acuity improved in two patients and remained stable in four patients. Two patients had improvement in lipid keratopathy at 6 months.

Conclusions: Combined intrastromal injection of bevacizumab and FND is an effective treatment for corneal neovascularization.